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The ophthalmic artery usually arises from the supraclinoid portion of the internal carotid artery. Here, we present an extremely rare case of abnormal origin of the ophthalmic artery from the anterior cerebral artery associated with the paraclinoid internal carotid artery aneurysm. As the embryology of the ophthalmic artery is complex, this case provides additional insight into the variation of the ophthalmic artery.

Intraorbital dural arteriovenous fistula(dAVF)is a very rare disease; therefore, an optimal treatment strategy has not yet been established. Here, we describe a case of successful dAVF treatment by performing transarterial embolization(TAE)with n-butyl-2-cyanoacrylate(NBCA). A 66-year-old male presented with right conjunctival injection, with no history of trauma. Magnetic resonance imaging(MRI)demonstrated a flow void in the right orbit. Digital subtraction angiography(DSA)revealed an AVF fed by a branch of the right ophthalmic artery(OA)and draining into the dilated right superior ophthalmic vein(SOV). A transvenous embolization(TVE)was planned, but it could not be performed because the facial vein was meandering. Hence, TAE with NBCA was performed, and the AVF was successfully occluded by this method. There has been no recurrence of intraorbital dAVF in three months since the treatment. Several recent studies have reported that TAE is an effective treatment for intracranial dAVF. However, there are insufficient reports of TAE with NBCA for intraorbital dAVF treatment. The anatomy of the OA needs to be known for the success of TAE in treating intraorbital dAVF, because TAE is a high-risk treatment. In this paper, we report a case wherein TAE with NBCA was performed for intraorbital dAVF and further review the other treatment options.

A rare case of ruptured carotid-ophthalmic aneurysm splitting the optic nerve was reported. A 52-year-old man presented with a sudden severe headache and bilateral visual deterioration. His right visual acuity was hand motion and the left was 2.0. His left visual field revealed a partial defect of the temporal visual field. Three-dimensional CT angiography revealed an ophthalmic aneurysm of 9 mm projecting superior-medially, The operation was performed to preserve the visual function as much as possible. The C2 portion aneurysm splitting the right optic nerve was visible. Before aneurysm clipping, the right anterior clinoid process and optic canal were drilled out to reduce the tension of the optic nerve. Intraoperative monitoring of visual evoked potential (VEP) under propofol anesthesia was performed to prevent further visual disturbance. Electroretinogram (ERG) was introduced to ascertain the arrival of the light stimulus at the retina even when the VEP could not be recorded. The right ERG was recorded, but the right VEP was flat. Both ERG and VEP were reproducible on the left side. Six months after the operation, the right visual acuity had improved to 0.08 and the visual field revealed nasal hemianopsia. The left visual acuity was unchanged while the visual field had improved to upper temporal quadrant hemianopsia. Various attempts to preserve the visual function were discussed.

We report a case of blindness due to occlusion of the ophthalmic artery following injection of autologous fat into the glabellar region for cosmetic surgery. A 30-year-old woman underwent aspiration of autologous fat from her gluteal region and injection of it into her breasts, nose, and glabellar area. At the time of injection into the glabellar area, she suffered nausea, pain, and visual loss in her right eye. She consulted an ophthalmologist. The first examination revealed that her right eye had loss of light perception, widespread retinal whitening, and obstruction of the retinal vessels of the fundus. It was suspected that she had occlusion of the central retinal artery, and drip infusion of urokinase and hyperbaric oxygen therapy were implemented. Since no improvement was seen, she was referred to Shinshu University hospital. Fundoscopy showed remarkable edema of the entire right retina and whitened retinal vessels. Fluorescein angiography showed no filling of the right retinal arterioles. Cerebral angiography showed complete obstruction of the right ophthalmic artery at its bifurcation. Subsequent administration of urokinase and corticosteroid had no effect. We considered that occlusion of the ophthalmic artery happened when autologous fat was injected into the glabellar area.

Traumatic intraorbital arteriovenous fistula is rare and only 2 cases have been reported. The authors report the case of a 70-year-old man with consciousness disturbance after non-penetrating head injury. CT scan showed diffuse subarachnoid hemorrhage in the basal cistern, and angiography on the next day revealed ophthalmic artery-superior ophthalmic vein fistula in the right orbit. During the clinical course of this lesion, there was mild chemosis of the right eye, without palsy of extraocular muscles. Both papilledema and bruit were absent. Conservative treatment was chosen. On the 26th day after the head injury, repeated angiography showed complete disappearance of the fistula. The patient was discharged on the 39th day without neurological deficit. In the other two reported cases, intraorbital A-V fistulae were caused by direct-penetrating injury. But, in the present case the head injury was non-penetrating and blunt type. The pathogenesis was considered to be indirect injury of the intraorbital vessels at the retrobulbar portion, approximately where the artery and the vein crossed. As regards to treatment, simple observation may be the first choice, and spontaneous obliteration can be expected. If this does not occur, either embolization or ligation of the ophthalmic artery is suggested as the second choice as proposed by Freitas MAL et al.

We reported a 72-year-old male with ischemic oculopathy due to ophthalmic artery stenosis followed by ipsilateral border zone infarction due to internal carotid artery stenosis. The patient had history of hypertension and diabetes mellitus. He had severe headache and visual disturbance of the right eye. He was diagnosed right neovascular glaucoma and left diabetic retinopathy (simple type), and received diuretics, beta-blockade and other anti-hypertensive drugs. One month later, he noticed left mild hemiparesis in a morning, and he experienced progression of left hemiparesis over a week. He was admitted to our hospital on the 11th day. He showed left complete hemiplegia, left sensory disturbance, anosognosia and left unilateral spatial neglect. His right eye was diagnosed neovascular glaucoma but left eye was normal. The 5th days CT showed low density area in the right terminal zone and bilateral periventricular lucency. At the same area, the 46th days MRI showed high intensity area in the T2-weighted image and low intensity area in the T1-weighted image. Cerebral angiography performed on the 33rd day, disclosed severe kinking at the cervical segment and 50% stenosis at the intracavernous segment in the right internal carotid artery, and 90% stenosis and post-stenotic dilatation of the right ophthalmic artery. Left internal carotid artery had each 60% stenosis at the cervical segment and the intracavernous segment. Left ophthalmic artery had severe stenosis from its beginning to distal part. This infarction was considered berder zone infarction by it's localization (terminal zone) and internal carotid artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The association of pituitary adenoma and adjacent cerebral aneurysm is not uncommon and acute hemorrhage into a pituitary adenoma is also a well recognized condition. However, the simultaneous occurrence of pituitary apoplexy with intracranial aneurysm is very rare. Such a case demonstrates the diagnostic difficulty in distinguishing between pituitary apoplexy and rupture of an aneurysm. We reported a patient with subarachnoid hemorrhage in whom a hemorrhage into the pituitary adenoma and a carotid-ophthalmic aneurysm was proven, and discussed the differential diagnosis and treatment. A 41-year-old man, who developed sudden severe headache with nausea and vomiting, was admitted to our hospital. Examination disclosed a mildly stuporous man with bilateral defects of upper lateral visual fields and lumbar puncture revealed subarachnoid hemorrhage. Plain radiographs of the skull showed an enlarged and eroded sella turcica. Carotid angiography revealed a left carotid-ophthalmic aneurysm. A plain CT scan demonstrated an acute suprasellar hematoma. A transsphenoidal operation was performed and postoperative course was uneventful.

The direct neck clipping for carotid-ophthalmic aneurysm is hazardous and difficult as compared with other intracranial aneurysms because of its location adjacent to the anterior clinoid process, the optic nerve, and the cavernous sinus. The authors discuss the visual abnormalities accompanied by carotid-ophthalmic aneurysm on the basis of our experiences with 30 patients with 33 aneurysms. Ten patients (4 of 14 with ruptured aneurysms, 6 of 16 intact aneurysms) had preoperative visual abnormalities. Of our series of patients, visual acuity and visual field were impaired in one eye. The most common field abnormalities were unilateral inner or upper side defects. In the patients whose aneurysms were intact, visual abnormalities had been slowly progressive over many months. Otherwise, 2 cases with ruptured aneurysm experienced their first visual symptoms at the same time their hemorrhage. According to the projection of aneurysm with respect to internal carotid artery, superomedial and posteromedial projections were common in the patients with visual abnormalities. Seven patients with visual dysfunctions were operated on. Improvement of the visual symptoms was observed in 3 cases. In these cases, complete collapse of the aneurysm with good decompression of the optic nerve was obtained at operation. Two patients deteriorated following surgery; this occurred in relation to attempts to clip the aneurysm neck directly, and optic nerve was probably excessively manipulated. Two patients had no change in visual symptom: one was treated with trapping of internal carotid artery combined with STA-MCA anastomosis, another had direct hemorrhage into the ipsilateral optic nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

The patient was 50 year-old female who was admitted to our department on June 13, 1973 complaining of left conjunctival injection and ipsilateral exophthalmos. Visual acuity of her right eye had been lost almost completely due to the previous ocular injury. Ophthalmological examination revealed left conjunctival injection, slight ipsilateral proptosis but pulsation of eye ball, chemosis and bruit were not so obvious. She had a visual acuity of 1.2 on her left eye. Left intraocular pressure was 30 mmHg while right was normal. Left CAG revealed a left carotid-cavernous fistula with anterior, posterior, inferior venous drainage. Temporal craniotomy was done and copper needles were inserted into the posterior part of Parkinson's triangle. An angiogram after operation demonstrated the persistency of the anterior and posterior venous drainage. 6 weeks later, electrothrombosis of left superior ophthalmic vein was carried out. After that, carotid-cavernous fistula disappeared perfectly. Important points of the surgical technique are; 1) to apply a silverclip to the tentorial edge just posterior to the third nerve, than anatomical realtionship of internal carotid artery, cavernous sinus and the clip applied are carefully investigated on the subsequent angiograms. 2) to repeat angiography several titate of embolization of cavernous sinus should often be checked.